But what exactly you should try first depends on what type of back pain you’re facing, the guidelines note.

For non-specific pain that’s not tied to an injury, heat and gentle stretches usually do the trick.

If you’ve got compression of the spinal nerve—such as from a herniated disc—you’ll likely have pain, weakness, or numbness in your leg as well as your back. This kind of pain can become chronic, but even then, the ACP suggests non-drug strategies.

With pain that’s present for fewer than 12 weeks, the recommendation is massage, spinal manipulation, acupuncture, and heat wraps. Suffering for longer than that? Then add in some mind-body therapies like guided relaxation and tai chi. Even talking about your pain—as in cognitive behavioral therapy—can be helpful, the ACP notes.

Still aching? The next level is drugs like duloxetine (branded as Cymbalta) for nerve pain relief or the narcotic pain killer tramadol.

The very last resort should be opioids, the ACP emphasizes. They note that there’s little evidence that drugs like Vicodin and OxyContin help low back pain, and they come with major risks for addiction and accidental overdose.

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